Annex A Questionnaire Refined Jan2024 1

Annex A PSA Approval No.
: NEDA-2337
Expires on: 31 December 2024
SURVEY ON THE SOCIOECONOMIC STATUS OF Z3R HOUSING BENEFICIARIES IN BARANGAY MARIKI AND BARANGAY
KASANYANGAN, ZAMBOANGA CITY
Hello! I am , from NATIONAL ECONOMIC AND DEVELOPMENT AUTHORITY IX. The National
Economic Development Authority (NEDA) Regional Office IX, headed by PHLORITA A. RIDAO as Regional Director, is conducting a face-to-face
interview survey to study the impact of Z3R Stilt Housing Relocation on the Socioeconomic Recovery of Zamboanga City Siege Internally Displaced Persons .
We will need relevant information before and after (past 12 months) the Zamboanga City Siege. The information gathered from this survey will be solely used
for the purpose of the study. Your household has been selected since you are one of the recipients of the project. We will get sufficient information from the
beneficiaries of the Z3R Housing Project. This survey/census was reviewed and cleared under the Statistical Survey Review and Clearance System (SSRCS) with
clearance number NEDA-2337 and expiration date 31 December 2024. We need your consent before we proceed with the interview.
This survey will take for not more than two (2) hours. There are no right or wrong answers for the questions and your answers will be kept strictly confidential
and cannot be used for any other purposes, investigation or law enforcement procedure, nor will it be published except in the form of statistical summaries
in which no reference to any person shall appear.
Your cooperation is earnestly solicited.
In compliance to RA 10173, otherwise known as the “Data Privacy Act of 2012”, kindly be informed of the following:
 Data controller: The data that will be collected under this form will be kept, managed and safeguarded by PHLORITA A. RIDAO, Regional Director of
National Economic and Development Authority Regional Office IX who will also be the principal data controller. Your data may also be disclosed
to, or accessed by, other staff or natural persons contracted by [the project] only for data entry purposes, wherein your details provided here will be
stored under strict confidentiality in a digital database exclusive only to [the project] and will become part of a larger dataset that will be aggregated and
statistically analysed.
 Purpose of collection: Data collected from you will exclusively be for the use of this study, particularly for scientific and statistical processing in support of
the Z3R Stilt Housing Relocation. We will also record the GPS coordinates of this household in case further verification of responses is needed. In no way
will analysis or reporting be individualized to only your information – your data will become part of an aggregated analysis and result. There are also
measures in place to make sure that your responses cannot be traced back to you.
Your responses will be coded and stored into a digital database, and this form will also be digitally scanned for records purposes and transparency
checks, but your name, household members names, and household GPS location will be redacted prior to scanning and digital storage.
 Data retention schedule: Your data shall exist for 10 years. After which, data will be destroyed to prevent future and possible unlawful use.
 Withdrawal of consent/request of information: Should you wish to (1) withdraw your consent, (2) update your information, (3) request for
transparency/extraction of data of yourself on the project’s database, (3) remove any and all records/data of you and your household from our database
system at any time during the said duration, kindly immediately get in touch with Dir. Phlorita A. Ridao.
 Data breach: Should a data breach occur, or your information stored in our database be compromised, you will be notified accordingly.
 I have read the terms and am aware of how data will be used. I consent to the use of my data for the purposes stated above and am
willing to be a study respondent.
 I have read the terms and am aware of how data will be used. I prefer not to disclose any information for the study as of this time.
(please tick the box and return this form to the secretariat)
Signature of Respondent or Thumbprint Signature of Interviewer Signature of Data Controller:
Date: Date: Date:
Household Information RECORD OF VISIT

Region* Household Code Certificate Visit 1st 2nd 3rd
of award Time
number
Began
Province* Treatment Household*** Ended
Mun/City Enumerator code Date (dd/mm/yyyy)
Barangay Spot Checker Code Result
Urban/Rural** Final Visit***
GPS Coordinates Codes for Result of Visit
Other identifier/s Address Not a
Completed Interview 1 6
Housing Unit
Refused 2 Housing Unit Not Found 7
Entire Household Absent for Critical Area, Flooded
3 8
Extended Period of Time Area
Vacant Housing Unit 4 Others (specify) 9
Housing Unit
5
Destroyed/Demolished
Certification
I hereby certify that the data gathered in this questionnaire were obtained/reviewed by me personally and in accordance with the instructions
stated in the interviewer’s manual.
Signature over Printed Signature over Printed Name
Name of Interviewer of Reviewer
Date Accomplished Date Reviewed
Enumerator’s Copy Page 1 of 33

Annex A PSA Approval No.: NEDA-2337
SURVEY ON THE SOCIOECONOMIC STATUS OF Z3R HOUSING BENEFICIARIES IN BARANGAY MARIKI AND BARANGAY
KASANYANGAN, ZAMBOANGA CITY
Hello! I am ,from NATIONAL ECONOMIC AND DEVELOPMENT AUTHORITY IX. The National Economic
Development Authority (NEDA) Regional Office IX headed by PHLORITA A. RIDAO as Regional Director, is conducting a face-to-face interview
survey to study the impact of Z3R Stilt Housing Relocation on the Socioeconomic Recovery of Zamboanga City Siege Internally Displaced Persons . We will
need relevant information before and after the Zamboanga City Siege. The information gathered from this survey will be solely used for the purpose of the
study. Your household has been selected since you are one of the recipients of the project. We will get sufficient information from the beneficiaries of the Z3R
Housing Project. This survey/census was reviewed and cleared under the Statistical Survey Review and Clearance System (SSRCS) with clearance number
NEDA-2337 and expiration date 31 December 2024. We need your consent before we proceed with the interview.
This survey will take for not more than two (2) hours. There are no right or wrong answers for the questions and your answers will be kept strictly confidential
and cannot be used for any other purposes, investigation or law enforcement procedure, nor will it be published except in the form of statistical summaries
in which no reference to any person shall appear.
Your cooperation is earnestly solicited.
In compliance to RA 10173 otherwise known as the “Data Privacy Act of 2012”), kindly be informed of the following:
 Data controller: The data that will be collected under this form will be kept, managed and safeguarded by PHLORITA A. RIDAO, Regional Director of
National Economic and Development Authority Regional Office IX who will also be the principal data controller. Your data may also be disclosed
to, or accessed by, other staff or natural persons contracted by [the project] only for data entry purposes, wherein your details provided here will be
stored under strict confidentiality in a digital database exclusive only to [the project] and will become part of a larger dataset that will be aggregated and
statistically analysed.
 Purpose of collection: Data collected from you will exclusively be for the use of [this study], particularly for scientific and statistical processing in support of
the Z3R Stilt Housing Relocation. We will also record the GPS coordinates of this household in case further verification of responses is needed. In no way
will analysis or reporting be individualized to only your information – your data will become part of an aggregated analysis and result. There are also
measures in place to make sure that your responses cannot be traced back to you.
Your responses will be coded and stored into a digital database, and this form will also be digitally scanned for records purposes and transparency
checks, but your name, household members names, and household GPS location will be redacted prior to scanning and digital storage.
 Data retention schedule: Your data shall exist for 10 years. After which, data will be destroyed to prevent future and possible unlawful use.
 Withdrawal of consent/request of information: Should you wish to (1) withdraw your consent, (2) update your information, (3) request for
transparency/extraction of data of yourself on the project’s database, (3) remove any and all records/data of you and your household from our database
system at any time during the said duration, kindly immediately get in touch with Dir. Phlorita A. Ridao.
 Data breach: Should a data breach occur, or your information stored in our database be compromised, you will be notified accordingly.
 I have read the terms and am aware of how data will be used. I consent to the use of my data for the purposes stated above and am
willing to be a study respondent.
 I have read the terms and am aware of how data will be used. I prefer not to disclose any information for the study as of this time.
(please tick the box and return this form to the secretariat)
Signature of Respondent or Thumbprint Signature of Interviewer Signature of Data Controller:
Date: Date: Date:
Household’s Copy Page 2 of 33

Respondent Information
Q1. Nickname:
Q7. What is your religion?........................................
Q2. Age (as of last birthday): ………………………….. Roman Catholic 1 Islam 5

Protestant 2 None 6
Q3. Sex at birth………………………………………………... Iglesia ni Cristo 3 Other (specify) 7
Male 1 Aglipay 4
Female 2
Refused to say 3
Q8. Please specify ethnical background.
Q4. Relationship to household head…………………….…
Tausug 1 Tagalog 5
Head of HH 1 Badjao 2 Cebuano 6
Wife/Spouse of HH 2 Sama-Bangingi 3 Other (specify) 7
Son/daughter of HH 3 Yakan 4
Son-in-law/daughter-in-law of HH 4
Grandson/Granddaughter of HH 5
Father/Mother of HH 6
Parents-in-law of HH 7
Sibling of HH 8
Sibling-in-law of HH 9
Sibling of Spouse 10
Sibling-in-law of Spouse 11
Niece/Nephew of HH 12
Niece/Nephew of Spouse 13
Other Relative 14
Other non-related 15
Maid/household help 16
Q5. How long have you resided in the barangay ?............... ____Years ____Months
Q6. How long have you resided in the

city/municipality?................................. ?........................ ____Years ____Months
*Codes for Region and Province

Region X – Northern
Region I – Ilocos Region 1 Region V – Bicol Region 5 10 BARMM 15
Mindanao
Ilocos Norte 38 Albay 7 Bukidnon 18 Basilan 11
Ilocos Sur 39 Camarines Norte 21 Camiguin 23 Lanao del Sur 46
La Union 43 Camarines Sur 22 Lanao del Norte 45 Maguindanao del Norte 48
Pangasinan 64 Catanduanes 25 Misamis Occidental 52 Maguindanao del Sur 49
Masbate 51 Misamis Oriental 53 Sulu 76
Region II – Cagayan Valley 2 Sorsogon 72 Tawi-Tawi 80
Batanes 13 Region XI – Davao Region 11
Cagayan 20 Region VI – Western Visayas 6 Davao de Oro 29 NCR 16
Isabela 41 Aklan 6 Davao del Norte 30 Metro Manila 85
Nueva Vizcaya 59 Antique 8 Davao del Sur 31
Quirino 66 Capiz 24 Davao Occidental 32
Guimaras 36 Davao Oriental 33
Region III – Central Luzon 3 Iloilo 40 ** Codes for Urban/Rural
Aurora 10 Negros Occidental 55 Region XII - SOCCSKSARGEN 12 Urban 1
Bataan 12 Cotabato 28 Rural 2
Bulacan 19 Region VII – Central Visayas 7 Sarangani 70
Nueva Ecija 58 Bohol 17 South Cotabato 73
Pampanga 63 Cebu 27 Sultan Kudarat 75 ***Yes/No Codes
Tarlac 79 Negros Oriental 56 Yes 1
Zambales 81 Siquijor 71 Region XIII - CARAGA 13 No 2
Agusan del Norte 4
Region IV-A - CALABARZON 4a Region VIII – Eastern Visayas 8 Agusan del Sur 5
Batangas 14 Biliran 16 Dinagat Islands 34
Cavite 26 Eastern Samar 35 Surigao del Norte 77
Laguna 44 Leyte 47 Surigao del Sur 78
Quezon 65 Northern Samar 57
Rizal 67 Samar 69 CAR 14
Southern Leyte 74 Abra 3
Region IV-B - MIMAROPA 4b Apayao 9
Marinduque 50 Region IX – Zamboanga Peninsula 9 Benguet 15
Occidental Mindoro 60 Zamboanga del Norte 82 Ifugao 37
Oriental Mindoro 61 Zamboanga del Sur 83 Kalinga 42
Palawan 62 Zamboanga Sibugay 84 Mountain Province 54
Romblon 68
Page 3 of 33
Module 1
Module 1.A Assets and Household Amenities

Before After
(2013) (2024
)
Q1A.1. How many families
reside in this household?
Q1A.2. In what type of Single house

building/house does the
Duplex 1
household reside?
Apartment/Accessoria/rowhouse 2
Condominium/condotel 3
Other multi-unit residential building (3 or more units)
Commercial/industrial/agricultural building 4
Institutional living quarter 5

Other types of building/house (e.g., bus/trailer, boat) specify 6
________
None (homeless) 7
Own House and Lot; or Owner-like Own House, Rent-Free Lot without
Q1A.3. What is the tenure Possession of House and Lot
a
Consent of Owner
e
status of the property
b Rent-Free House and Lot with f
occupied by the family? Rented House/Room Including Lot
Consent of Owner
Since when did the family Own House but Rented Lot Rent-Free House and Lot without
c g
live in this house? Consent of Owner
Yr.__ Yr.__
Own House, Rent-Free Lot with d Mortgaged
Consent of Owner
Yes 1 No 2
Q1A.4. Is there electricity in
the house?
Q1A.5. No. of rooms in the
house
Q1A.6. No. of
Bedrooms/sleeping rooms
Private, within household 1 Shared with other households 2
Q1A.7. Is the household’s
toilet facility…
Flush or Pour Flush Toilet to Piped 1 Pit Latrine with Slab 7
Q1A.8. What toilet facility Sewer System
does the household Flush or Pour Flush Toilet to Septic 2 Pit Latrine without Slab/Open Pit 8
use? Tank
Flush or Pour Flush Toilet to Pit 3 Composting Toilet 9
Latrine
Flush or Pour Flush Toilet to 4 Bucket Toilet 10
somewhere else
Flush, don't know where 5 Drop/Hanging Toilet 11
Pit Latrine, Ventilated Improved 6 No Facility/Bush/Field/River 12
Q1A.9. What is the Pipe into dwelling Tanker truck

1 9
household’s main source of Piped into yard/plot Cart with small tank
2 10
water supply for Piped to neighbor Water refilling station
3 11
drinking? Public tap/standpipe Bottled water
4 12
Q1A.10. What is the Tube well/borehole Sachet water
5 13
household’s main source of Protected well Unprotected (open dug well)
6 14
water supply for cooking? Protected spring 7
Unprotected spring 15
Rainwater 8
Surface water (river, dam, lake, 16
Q1A.11. What is the ponds/stream/canal/irrigation
household’s main source of channel
Other, please specify _____________________ 17
water supply for laundry?
Page 4 of 33
Q1A.12. What is the

household’s main source
of water supply for
bathing?
Q1A.13. If the main source
of water is located outside of
the house, how many
minutes does it take to reach
it, one way?
Q1A.14. What does the Electricity 1 Straw, shrubs, grass 8
household use for cooking
food? Charcoal 2 Natural gas 9
Biogas 3 Kerosene 10
Agricultural crop 4 Wood 11
Animal dung 5 Butane 12
LPG 6 Other 13
Coal, lignite 7 No food cooked in household 14
Q1A.15. Does the household own any of the following assets?
Yes 1 No 2
Before After Before After

(2013) (2024 (2013) (2024)
)
Television Set Jeep
Boat Tricycle
Cellular phone/ Mobile phone Gas Range/Stove w/Oven
Refrigerator Motorcycle
Stand-alone Freezer Personal Computer (desktop, laptop, notebook, net book, tablet
and others)
Washing Machine Microwave Oven/Oven Toaster
Air Conditioning Home Entertainment System
Living Room/Sala Set Gas Stove
Dining Set Digital Camera
Personal Car/Van Videoke/Magic Sing
After you had transferred to your new house in the relocation site, how long before you started acquiring appliances? No. of months __________
Q1A.16. Does your family subscribe to any

Befor After
of the following before the siege / after the
e (last
siege? 12mos)
(last
12mos)
Cable (eg SKYCable, Destiny, Cignal, etc)

Broadband Internet/DSL
Ye 1 No 2 Video Streaming Services (NETFLIX, iFLIX, HOOQ,/iWANT, Viu,
s etc)
Rest of 1.A. is to be asked to the respondent (Before the siege condition)

Q1A.17. What type of Strong Materials (galvanized iron, 1 Mixed but Predominantly Strong 4
construction materials is aluminum, tile, concrete, brick, stone, Materials
the house’s roof made wood, asbestos
of? Light Materials (cogon, nipa, anahaw) 2 Mixed but Predominantly Light 5
Materials
Salvaged/Makeshift Materials 3 Mixed but Predominantly Salvaged 6
Materials
Q1A.18. What type of Strong Materials (tile, concrete, brick, 1 Mixed but Predominantly Strong 4
construction materials stone, wood, plywood) Materials

Light Materials (cogon, nipa, anahaw, 2 Mixed but Predominantly Light 5
are the outer walls
bamboo) Materials
made of? Mixed but Predominantly Salvaged
Salvaged/Makeshift Materials 3 6
Materials
Q1A.19. Outdoor Heavy high quality materials (concrete, 1 Of light and cheap materials, poorly 4
durability of home wood and concrete or first class wood, constructed, semi-permanent
bricks), permanent
Of good quality materials (wood and 2 Temporary structure, barong-barong 5
concrete or first class woods), generally type of a poorly constructed one-room
permanent affair
Of mixed light and heavy materials, semi- 3
permanent
Q1A.20. Indoor quality / Well painted, not in need of repair 1 Generally unpainted and badly in 4
house maintenance need of repair
Well painted but may need a new coat 2 5
Unpainted and dilapidated
of paint and some minor repairs
Painted but needs a new coat of paint 3 6
NA – No chance to observe
and needs some repairs
Rest of 1.A. is to be answered based on observation, no need to ask the respondent. (Present condition)
Q1A.17. What type of Strong Materials (galvanized iron, 1 Mixed but Predominantly Strong 4
construction materials is aluminum, tile, concrete, brick, stone, Materials
the house’s roof made wood, asbestos
of? Light Materials (cogon, nipa, anahaw) 2 Mixed but Predominantly Light 5
Materials
Materials
Q1A.18. What type of Strong Materials (tile, concrete, brick, 1 Mixed but Predominantly Strong 4
construction materials stone, wood, plywood) Materials
are the outer walls made Light Materials (cogon, nipa, anahaw, 2 Mixed but Predominantly Light 5
of? bamboo) Materials
Materials
Q1A.19. Outdoor Heavy high quality materials (concrete, 1 Of light and cheap materials, poorly 4
durability of home wood and concrete or first class wood, constructed, semi-permanent
bricks), permanent
Of good quality materials (wood and 2 Temporary structure, barong-barong 5
concrete or first class woods), generally type of a poorly constructed one-room
permanent affair
Of mixed light and heavy materials, semi- 3
permanent
Q1A.20. Indoor quality / Well painted, not in need of repair 1 Generally unpainted and badly in 4
house maintenance need of repair
Well painted but may need a new coat 2 5
Unpainted and dilapidated
of paint and some minor repairs
Painted but needs a new coat of paint 3 6
NA – No chance to observe
and needs some repairs
Module 1.B. Household Demographic and Socio-economic Characteristics

Use the Household Information Grid in recording the answers of the questions below.
Please give me the names of all household members in your family, including your household help.
Ask for the nickname or common name of the household members. There is no need to ask for the full name; the
Q1B.1. name will be used to anchor your questions about the family member for the next questions. List the members on
the second column of the grid, beginning from the household head.
Ask the succeeding questions for each household member.

Q1B.2. How often is [HOUSEHOLD MEMBER] present in the household?
Q1B.3 How is [HOUSEHOLD MEMBER] related to the head of the household?
When is the birthday of [HOUSEHOLD MEMBER]?
Q1B.4. - Q1B.5.
Record the month and year of birth
Q1B.6. How old is [HOUSEHOLD MEMBER] as of his/her last birthday?
Q1B.7 What is the sex at birth of [HOUSEHOLD MEMBER ?
Q1B.8. What is the marital status of [HOUSEHOLD MEMBER]?
Q1B.9. What is the highest educational attainment completed by [HOUSEHOLD MEMBER]?
Is [HOUSEHOLD MEMBER] currently attending school or day care?
Q1B.10. If no, proceed to Q1A.29.
Q1B.11. What educational level is [HOUSEHOLD MEMBER] currently in?
Q1B.12. What type of school is [HOUSEHOLD MEMBER] currently going to?
Page 6 of 33
Household Information
Q1B.1 Q1B.2 Q1B.3 Q1B.4 Q1B.5 Q1B.6 Q1B.7 Q1B.8 Q1B.9 Q1B.10 Q1B.11 Q1B.12
Household Member Date of Birth
Member Number
Current grade/level
Currently Studyingf
Type of schoolh
Relation to HH
Marital Statusd
Nickname
Sex at birthc
Age on last
Presence in
Educational
Householda
Attainmente
attendingg
MM YYYY
birthday
Highest
Headb
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
a Presence in Household Codes (Q1B.2)
Permanent (at least 6 mos. In past 12m) 1 eHighest Educational Attainment Codes (Q1B.9) gCurrent
Transient (doesn’t come home in the past 6m) 2 grade/level Attending (Q1B.11)
OCW/OFW 3 No Grade Completed 0
Working outside the city, etc 4 Kinder/Prep/Nursery 1
Student studying outside the city 5 Elementary
Grade 1 11
bRelation to HH Head Codes (Q1B.3) Grade 2 12
Head of HH 1 Grade 3 13
Wife/Spouse of HH 2 Grade 4 14
Son/daughter of HH 3 Grade 5 15
Son-in-law/daughter-in-law of HH 4 Grade 6/7 or Elementary Graduate 16
Grandson/Granddaughter of HH 5 Secondary
Father/Mother of HH 6 1st year or Grade 7 21
Parents-in-law of HH 7 2nd year or Grade 8 22
Sibling of HH 8 3rd year or Grade 9 23
Sibling-in-law of HH 9 4th year or Grade 10 24
Sibling of Spouse 10 5th year or Grade 11 25
Sibling-in-law of Spouse 11 6th year or Grade 12 or High School Graduate 26
Niece/Nephew of HH 12 College
Niece/Nephew of Spouse 13 1st year 31
Other Relative 14 2nd year 32
Other non-related 15 3rd year or higher 33
Maid/household help 16 College Graduate 34
Post Graduate
cSex at birth codes (Q1B.7) With some
fCurrently units earned/enrolled
Studying Codes (Q1B.10) 36
Female 1 Graduate,
Yes, schoolspecify PhD/Master’s
1 Degree 37
Male 2 Yes, day care
Vocational Studies 2 38
Refused to Answer 3
No 3
dMarital Status Codes (Q1B.8) hType of School (Q1B.12)

Single 1
Public 1
Married 2
Private Non-sectarian 2
Living-in/Common-Law 3
Private Sectarian 3
Widowed 4
Separated 5
Divorced 6
Annulled 7
Unknown 8
Q1B.13. How many household members are there in total? 🖵

Before the siege

Q1C.1 Q1C.2 Q1C.3 Q1C.4 Q1C.5 Q1C.6 Q1C.7 Q1C.8.1.1 Q1C.8.1.2 Q1C.8.1.3 Q1C.8.1.4 Q1C.8.1.5 Q1C.8.1.6 Q1C.8.2.1 Q1C.8.2.2 Q1C.8.2.3 Q1C.8.2.4 Q1C.8.2.5 Q1C.8.2.6
Occupation SALARIES AND WAGES FROM REGULAR EMPLOYMENT SALARIES AND WAGES FROM SEASONAL / OCCASIONAL
Status of Job/
(Actual EMPLOYMENT
OFW-5 years
OF Indicator
Member Code
Answer) CASH EARNINGS EARNINGS IN KIND CASH EARNINGS EARNINGS IN KIND

Job past 12
Nature of
Payment
Business
Basic Bonuses, Total Basic Housing, Total Basic Bonuses, Total Basic Housing, Total
Basis of
Salaries Honoraria Salaries Clothing, Salaries Honoraria Salaries Clothing,
Work
mons
and and and Food, etc. and and and Food, etc.
Wages Gratuities Wages Wages Gratuities Wages
After the siege

Q1C.1 Q1C.2 Q1C.3 Q1C.4 Q1C.5 Q1C.6 Q1C.7 Q1C.8.1.1 Q1C.8.1.2 Q1C.8.1.3 Q1C.8.1.4 Q1C.8.1.5 Q1C.8.1.6 Q1C.8.2.1 Q1C.8.2.2 Q1C.8.2.3 Q1C.8.2.4 Q1C.8.2.5 Q1C.8.2.6
Occupation SALARIES AND WAGES FROM REGULAR EMPLOYMENT SALARIES AND WAGES FROM SEASONAL / OCCASIONAL
Status of Job/
(Actual EMPLOYMENT
OFW-5 years
OF Indicator
Member Code
Answer) CASH EARNINGS EARNINGS IN KIND CASH EARNINGS EARNINGS IN KIND

Job past 12
Nature of
Payment
Business
Basic Bonuses, Total Basic Housing, Total Basic Bonuses, Total Basic Housing, Total
Basis of
Salaries Honoraria Salaries Clothing, Salaries Honoraria Salaries Clothing,

Work
mons
and and and Food, etc. and and and Food, etc.
Wages Gratuities Wages Wages Gratuities Wages
d
Q1C.5 Basis of Payment
In kind, imputed (received as wage or 1
salary)
Per piece 2
Per hour 3
Per day 4
Monthly 5
Pakyaw 6
Other Salaries/wages 7
Not salaries/wages (eg commission 8
basis) Page 8 of 33
Mixed/Inconsistent 9
No income 10
2
(Q1B.1) Codes Expires on: 31 December 2024
Working 1
Non-working 2
a
Q1C.3. Nature of Work Codes
Worked for private household – worked in a private establishment for pay, in cash or in 1
kind. Examples are domestic helper, household cook, gardener, family driver, etc.
Worked for a private establishment – worked in a private establishment for pay, in cash or 2
in kind. This class includes not only persons working for private industry but also those
working for a religious groups (priest, acolyte, missionary, nuns/sisters, etc.), unions and
non-profit organizations
Worked for gov’t/govt. corp – worked for the government or a government corporation or 3
any of its instrumentalities
Self-employed without any employee – worked for profit or fees in own 4
business, farm, profession or trade without any paid employee e
Q1C.6 OFW for 5 Consistent years
Employer in own family-operated farm or business – working in his own 5
Yes 1
business, farm, profession or trade that had one or more regular paid
No 2
employees, including paid family members
Worked with pay in own family-operated farm or business – worked in own 6
family-operated farm or business and receives cash or a fixed share of the e
Q1C.7 OF Indicator
produce as payment for his service OFW with contract 1
Worked without pay in own family-operated farm or business – a member of 7 Other OFW with no contract 2
the family worked without pay in a farm or business operated by another Employees in PH embassy, consulates 3
member living in the same household. The room and board and any cash and other missions
allowance given as incentives are not counted as compensation for these Students abroad/tourists 4
family workers.
c
Q1C.4 Job Status Codes
Permanent Job/Business 1
Casual/Seasonal/Short-term/unpaid 2
family work
Work for employer on Daily/Weekly 3
basis
Page 9 of 33
Please record answers in the Household Income grid on the previous page for Q1C.1 to Q1C.15.2.
Did [HOUSEHOLD MEMBER] do any work for at least one hour, including work from home or telecommuting, or have a
Q1C.1 business (before the siege / after the siege)?
Choose appropriate code in the last row of table. If answer is 2, skip to Q1C.6
What is [HOUSEHOLD MEMBER]’s occupation?
Q1C.2. Write actual answer, consider biggest source of income if more than 1 occupation.
What was [HOUSEHOLD MEMBER]’s nature of work?
Q1C.3. Based on main occupation answer in Q1C.2, choose appropriate code in the last row of table
What is [HOUSEHOLD MEMBER’S] status in job or business?
Q1C.4. Choose appropriate code in the last row of table.
What is [HOUSEHOLD MEMBER]’s basis of payment in his/her occupation?
Q1C.5. Choose appropriate code in the last row of table.
Ask if respondent indicated the house member is working abroad in Q1C.2
Q1C.6. Has [HOUSEHOLD MEMBER] been working abroad for 5 straight years?
Q1C.7 [skip if household member is not overseas]
If respondent indicated codes 2 or 3 in Q1C.4 ► skip Q1C.8.1.1 to Q1C.8.1.4

(Before the siege / After the siege), how much basic salaries or wages did [HOUSEHOLD MEMBER] regularly receive
Q1C.8.1.1
from employment in cash, excluding allowances/honoraria and tips?
(Before the siege / After the siege), how much did [HOUSEHOLD MEMBER] regularly receive from employment in cash
Q1C.8.1.2
bonuses, honoraria, gratuities, tips and commissions?
Q1C.8.1.2 [sum the response in Q1C.8.1.1 and Q1C.8.1.2]
(Before the siege / After the siege), how much basic salaries or wages did [HOUSEHOLD MEMBER] regularly receive
Q1C.8.1.3
from employment in kind, excluding allowances/honoraria and tips?
(Before the siege / After the siege), how much did [HOUSEHOLD MEMBER] regularly receive from employment in kind
Q1C.8.1.4
housing, food, grocery, clothing, and medical benefits?
If respondent indicated code 1 in Q1C.4 ►skip Q1C.8.2.1 to Q1C.8.2.4

(Before the siege / After the siege), how much basic salaries or wages did [HOUSEHOLD MEMBER] receive in cash,
Q1C.8.2.1 excluding
allowances/honoraria and tips as seasonal/occasional workers?
(Before the siege / After the siege), how much did [HOUSEHOLD MEMBER] receive in cash bonuses, honoraria,
Q1C.8.2.2
gratuities, tips and commissions as seasonal/occasional workers?
(Before the siege / After the siege), how much basic salaries or wages did [HOUSEHOLD MEMBER] receive in kind,
Q1C.8.2.3
excluding allowances/honoraria and tips as seasonal/occasional workers?
(Before the siege / After the siege), how much did [HOUSEHOLD MEMBER] in kind housing, food, grocery, clothing, and
Q1C.8.2.4
medical benefits receive as seasonal/occasional workers?
Please record answers in the Entrepreneurial Activities grid on the next page for Q1C.1 to Q1C.15.2.
Q1C.9. (Before the siege / After the siege), did you or any member of your family engage as operator in any of the following
entrepreneurial activities?
Go through every row of the first column. Check whether Yes or No in Q1C.9 column in the grid for every row.
If the is code 2 ►skip questions Q1C.10 – Q1C.15.2 for that row and proceed to the next row.
What is the total value of output produced by the household from [MENTION ANSWER IN Q1C.9] business?
Q1C.10. Estimate at prevailing market price
Q1C.11. What is the total value of output sold for cash by the household from [MENTION ANSWER IN Q1C.9] business?
Q1C.12. What is the total value of output given as gifts by the household from [MENTION ANSWER IN Q1C.9] business?
What is the total value of output consumed by the household from [MENTION ANSWER IN Q1C.9] business?
What is the total value of output kept by the household in stock from [MENTION ANSWER IN Q1C.9] business?
(Before the siege / After the siege) did you or any member of your family incur expenses, in cash, in the operation of
Q1C.15.1
[MENTION ANSWER IN Q1C.9] business?
(Before the siege / After the siege) did you or any member of your family incur expenses, in kind, in the operation of
Q1C.15.2
[MENTION ANSWER IN Q1C.9] business?
Page 10 of 33
Entrepreneurial Activities
Beforethe
After thesiege
siege Q1C.9. Q1C.10 Q1C.11 Q1C.12 Q1C.13 Q1C.14 Q1C.15.1 Q1C.15.2
Sold for Cash Value Gifted Value Stock on Cost in
No Yes ► Total Value Cost in Kind
consumed hand Cash
Q1C.9.3 FISHING such as capture fishing (with a boat of three tons
or less); gathering fry, shells, seaweeds, etc.; and culturing fish, oyster, mussel, ►
etc.
Q1C.9.5 WHOLESALE AND RETAIL including market vending, sidewalk vending ►
and peddling
Q1C.9.6 MANUFACTURING such as mat weaving, tailoring, dressmaking, bagoong ►
making, fish drying, etc.
Q1C.9.8 TRANSPORTATION AND STORAGE such as operation of jeepneys or ►
taxis, storage and warehousing activities, etc.
Q1C.9.10 CONSTRUCTION or repair of a house, building or any structure. ►
Q1C.9.11 ACTIVITIES NOT ELSEWHERE CLASSIFIED including ►
electricity, gas and water, financial, insurance, real estate and business services,
communication services, messenger services, etc.
Page 11 of 33
PSA Approval No.: NEDA-2337
Q1C.16. (Before the siege / After the siege), did you or any member of your family receive in cash any receipt, gift or other forms of assistance
from abroad?
No ► proceed to Q1C.17
Yes ► Ask: (Before the siege / After the siege), how much did you
receive in.…
Record answer in grid below
CASH RECEIPTS, GIFTS, SUPPORT, RELIEF AND OTHER FORMS OF ASSISTANCE FROM ABROAD In Cash
Before After
Q1C.16.1 Cash received from family members who are Overseas Contract Workers (OCW)
Q1C.16.2 Cash received from family members who are working abroad other than OCW
Q1C.16.3 Pensions, retirement, workmen’s compensation and other benefits
Q1C.16.4 Cash gifts, support, relief, etc. from abroad
Q1C.16.5 Dividends from investment abroad
Q1C.16.7 Total
Q1C.17. (Before the siege / After the siege), did you or any member of your family receive in cash any gift, support, assistance or relief from
domestic source?
receive in.…
CASH RECEIPTS, SUPPORT, ASSISTANCE AND RELIEF FROM DOMESTIC SOURCE In cash
Before After
Q1C.17.1 Other Families
Q1C.17.2 Government institutions
Q1C.17.2.1 Conditional Cash Transfer/Pantawid
Q1C.17.2.2 Rice subsidy
Q1C.17.2.3 Tax Reform Subsidy/Unconditional Cash Transfer
Q1C.17.2.4 Senior citizen pension
Q1C.17.2.5 Others, specify
Q1C.17.3 Private Institutions
Q1C.17.4 Total
Q1C.18. Before the siege / After the siege, did you or any member of your family receive in cash or in kind, rentals from non-agricultural land,
buildings, spaces or other properties?
receive in.…
RENTALS RECEIVED FROM NON-AGRICULTURAL LANDS, BUILDINGS,

SPACES AND OTHER PROPERTIES In cash In kind
Q1C.18.1 Land
Q1C.18.2 Buildings
Q1C.18.3 Spaces
Q1C.18.4 Other properties
Q1C.18.5 Total
Page 12 of 33
Q1C.19. Before the siege / After the siege, did you or any member of your family receive in cash or in kind, interest from bank deposits and
loans extended to other families?
receive in.…
INTEREST
In cash In kind
Q1C.19.1 Interest from Bank Deposits
Q1C.19.2 Interest from Loans
Q1C.19.3 Total
Q1C.20. (Before the siege / After the siege), did you or any member of your family receive in cash, pension and retirement, employee compensation, or social security
benefits?
receive in.…
PENSION AND RETIREMENT, EMPLOYEE COMPENSATION AND SOCIAL

SECURITY BENEFITS In cash In kind
Q1C.20.1 Pension and retirement
Q1C.20.2 Employee compensation
Q1C.20.3 Social security benefits
Q1C.20.4 Total
Q1C.21. (Before the siege / After the siege), did you or any member of your family receive in cash or in kind, other receipts such as sale of
real property; sale of personal property such as (clothing, jewelry, etc.); loans from other families, business firms and government institutions
for current consumption and investment; payment received for loans granted to others (excluding interest); withdrawals from
savings/business equity; net winnings from gambling, profits from sale of stocks, back pay and proceeds from insurance, inheritance or other
receipts?
receive in.…
Other Receipts
In cash In kind
Sale of real property
Q1C.21.1
Sale of personal property
Q1C.21.2
Loans from other families
Q1C.21.3
Loans from business firms (including sari-sari stores and
Q1C.21.4
government institutions
Q1C.21.5 Payments received for loans granted to others
Q1C.21.6 Withdrawals from savings/business equity
Q1C.21.7 Net winnings from gambling, sweepstakes and raffle
Q1C.21.8 Profits from sale of stocks, bonds and real and personal
property
Q1C.21.9 Back pay and proceeds from insurance
Q1C.21.10 Inheritance
Q1C.21.11 Other receipts (tax refund, dowries, prizes received from
tournaments, etc.)
Q1C.21.12 Total
Q1C.22 . (Before the siege / After the siege), has any member of your family received benefits/grants/assistance/payment fromPage
any 13
of the
of 33
following programs? (check all that apply)
Social Assistance
Regular Conditional Cash Transfer – Pantawid Pamilyang Pilipino Program (4Ps) ► proceed to ask
Modified Conditional Cash Transfer – Pantawid Pamilyang Pilipino Program (4PS) which family member
Unconditional Cash Transfer (UCT) under Tax Reform Program is the recipient and list
in the Social
Indigent Senior Citizen’s Social Pension (SPISC or SocPen)
Assistance
Individual Medical assistance Program (IMAP) under Philippine Charity Sweepstakes Office (PCSO) grid on the next page.
Student Financial Assistance Programs (StuFAP) other than Universal Access to Quality Tertiary Proceed to asking
Education (UAQTE) Q1C.22.1 - Q1C.22.2
Emergency Shelter Assistance
Regular Conditional Cash Transfer – Pantawid Pamilyang Pilipino Program (4Ps)
None
Use the Social Assistance grid on the next page to record answers of Q1C.22.1 - Q1C.22.2.
Q1C.22.1 How many times did your family receive benefits/grants/assistance/payments from the program (Before the siege / After the
siege)?
How much as received by [family member] in cash, including value of goods received from the program (Before the siege /
Q1C.22.2
After the siege?
Page 14 of 33
PSA
Approval No.: NEDA - 2337

Social Assistance
Before the Siege:
Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2
Regular Conditional Cash Modified Conditional Cash Individual Medical assistance Student Financial Assistance
HH Member code
Unconditional Cash Indigent Senior Citizen’s

Transfer – Transfer – Pantawid Program (IMAP) under Programs (StuFAP) other than Emergency Shelter
Transfer (UCT) under Tax Social Pension (SPISC or
Pantawid Pamilyang Pilipino Pamilyang Pilipino Program Philippine Charity Universal Access to Quality Assistance
Program (4Ps) (4PS) Reform Program SocPen) Sweepstakes Office (PCSO) Tertiary Education (UAQTE)
# times Amount in Cash # times Amount in Cash # times Amount in Cash # times Amount in Cash # times Amount in Cash # times Amount in Cash # times Amount in Cash
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
PSA
Approval No.: NEDA - 2337

Social Assistance Expires on: 31 December 2024
Page 15 of 33
After the Siege:
Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2 Q1C.22.1 Q1C.22.2
Regular Conditional Cash Modified Conditional Cash Individual Medical assistance Student Financial Assistance
HH Member code
Unconditional Cash Indigent Senior Citizen’s

Transfer – Transfer – Pantawid Program (IMAP) under Programs (StuFAP) other than Emergency Shelter
Transfer (UCT) under Tax Social Pension (SPISC or
Pantawid Pamilyang Pilipino Pamilyang Pilipino Program Philippine Charity Universal Access to Quality Assistance
Program (4Ps) (4PS) Reform Program SocPen) Sweepstakes Office (PCSO) Tertiary Education (UAQTE)
# times Amount in Cash # times Amount in Cash # times Amount in Cash # times Amount in Cash # times Amount in Cash # times Amount in Cash # times Amount in Cash
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Page 16 of 33
PSA Approval No.: NEDA - 2337
Module 1.D. Household Expenditure

FOOD Consumption
If YES, how much on the average do you
Q1D.1.1 Before the siege, did you or any member of your spend per week?
family consume… In cash/On In kind Received
credit Value Source* as gifts
Q1D.1.1. Bread and Cereals (including rice, corn, flour, ☐ No ☐ Yes ►
bread, pasta)
Q1D.1.2. Meat (fresh, chilled, frozen, dried; salted or ☐ No ☐ Yes ►
smoked, preserved or processed incl. offal)
Q1D.1.3. Fish and Seafood (fresh, chilled, frozen, dried, ☐ No ☐ Yes ►
smoked or salted)
Q1D.1.4. Milk, Cheese and Eggs (incl. raw condensed, ☐ No ☐ Yes ►
evaporated, pasteurized, powdered milk, yoghurt, cream,
milk-based dessert beverages and other products, soya milk
Q1D.1.5. Oils and fats (butter, margarine, edible oils – corn ☐ No ☐ Yes ►
oil, coconut oil incl. coconut milk, edible animal fats like lard)
Q1D.1.6. Fruits (fresh, dried/preserved, fruit nuts and seeds, ☐ No ☐ Yes ►
fruit-based products, kaong preserves, nata de coco)
Q1D.1.7. Vegetables (leafy vegetables, root vegetables, ☐ No ☐ Yes ►
tubers, preserved vegetables or processed)], including
products of tuber vegetables like potato chips, cassava cake,
halaya, camote cue, etc
Q1D.1.8. Sugar, Jam, Honey, Chocolate and Confectionery ☐ No ☐ Yes ►
(sugar, jams, marmalade, jellies, honey, chocolates, ice
cream, sorbet, edible ice, other sugar incl candies, chewing
gum, pastilles, meringue, bukayo etc)
Other food Products
Q1D.1.9. Salt, Spices ,Sauces, culinary herbs, Condiments, ☐ No ☐ Yes ►
Vinegar
Q1D.1.10. Homogenized baby food and dietary preparations ☐ No ☐ Yes ►
Non-alcoholic beverages
Q1D.1.11. Coffee, Tea and cocoa (incl decaf) ☐ No ☐ Yes ►
Q1D.1.12. Mineral Water, Soft drinks, fruit and vegetable ☐ No ☐ Yes ►
juices (incl. power juices, concentrates or ready to drink juice
and other sugar-sweetened beverages like Lipovitan, Red
Bull, Extra Joss, Cobra, Gatorade)
TOTAL
*CODES (SOURCES OF IN KIND)
1 - FAMILY SUSTENANCE ACTIVITIES
2 - ENTREPRENEURIAL ACTIVITIES
3 - NET SHARE OF CROPS, FRUITS AND VEGETABLES PRODUCED, AQUACULTURE
PRODUCTS PRODUCED OR LIVESTOCK AND POULTRY RAISED BY OTHER HOUSEHOLDS
Page 17 of 33

Q1D.1.2 After the siege, did you or any member of your spend per week?
Q1D.1.1. Bread and Cereals (including rice, corn, flour, ☐ No ☐ Yes ►
bread, pasta)
Q1D.1.2. Meat (fresh, chilled, frozen, dried; salted or ☐ No ☐ Yes ►
smoked, preserved or processed incl. offal)
Q1D.1.3. Fish and Seafood (fresh, chilled, frozen, dried, ☐ No ☐ Yes ►
smoked or salted)
Q1D.1.4. Milk, Cheese and Eggs (incl. raw condensed, ☐ No ☐ Yes ►
evaporated, pasteurized, powdered milk, yoghurt, cream,
milk-based dessert beverages and other products, soya milk
Q1D.1.5. Oils and fats (butter, margarine, edible oils – corn ☐ No ☐ Yes ►
oil, coconut oil incl. coconut milk, edible animal fats like lard)
Q1D.1.6. Fruits (fresh, dried/preserved, fruit nuts and seeds, ☐ No ☐ Yes ►
fruit-based products, kaong preserves, nata de coco)
Q1D.1.7. Vegetables (leafy vegetables, root vegetables, ☐ No ☐ Yes ►
tubers, preserved vegetables or processed)], including
products of tuber vegetables like potato chips, cassava cake,
halaya, camote cue, etc
Q1D.1.8. Sugar, Jam, Honey, Chocolate and Confectionery ☐ No ☐ Yes ►
(sugar, jams, marmalade, jellies, honey, chocolates, ice
cream, sorbet, edible ice, other sugar incl candies, chewing
gum, pastilles, meringue, bukayo etc)
Other food Products
Q1D.1.9. Salt, Spices ,Sauces, culinary herbs, Condiments, ☐ No ☐ Yes ►
Vinegar
Q1D.1.10. Homogenized baby food and dietary preparations ☐ No ☐ Yes ►
Non-alcoholic beverages
Q1D.1.11. Coffee, Tea and cocoa (incl decaf) ☐ No ☐ Yes ►
Q1D.1.12. Mineral Water, Soft drinks, fruit and vegetable ☐ No ☐ Yes ►
juices (incl. power juices, concentrates or ready to drink juice
and other sugar-sweetened beverages like Lipovitan, Red
Bull, Extra Joss, Cobra, Gatorade)
TOTAL
PRODUCTS PRODUCED OR LIVESTOCK AND POULTRY RAISED BY OTHER HOUSEHOLDS
Page 18 of 33
Alcoholic Beverages and Tobacco
If YES, how much on the average do you spend

Q1D.2.1 Before the siege, did you or any member of your per week?
Q1D.2.1.1 Alcoholic Beverages (Liquor, Wine, Beer) ☐ No ☐ Yes ►
Q1D.2.1.2Tobacco (cigarette, cigars, chewing tobacco, ☐ No ☐ Yes ►

others)
TOTAL
PRODUCTS PRODUCED OR LIVESTOCK AND POULTRY RAISED BY OTHER
HOUSEHOLDS
If YES, how much on the average do you spend

Q1D.2.2 After the siege, did you or any member of your per week?
Q1D.2.2.1. Alcoholic Beverages (Liquor, Wine, Beer) ☐ No ☐ Yes ►
Q1D.2.2.2 Tobacco (cigarette, cigars, chewing tobacco, ☐ No ☐ Yes ►

others)
TOTAL
PRODUCTS PRODUCED OR LIVESTOCK AND POULTRY RAISED BY OTHER
HOUSEHOLDS
Clothing and footwear

If YES, how much on the average did you
Q1D.3.1 Before the siege, did you or any member of your spend before the siege ?
family purchase in cash or on credit, or receive as gift
Total In cash/On Received as
any… credit gifts
Clothing
Q1D.3.1.1. Clothing Materials ☐ No ☐ Yes ►
Q1D.3.1.2. Garments (for men, boys, women, girls, infants, ☐ No ☐ Yes ►
sports activity, ties, handkerchiefs, sports garments like track
suits, leotards; and others like crash helmet for motorcycles
and bicycles, etc)
Q1D.3.1.3. Cleaning, repair and rental of clothing (incl. dry ☐ No ☐ Yes ►
cleaning, laundering, cleaning, dyeing services, altering of
garments)
Footwear
Q1D.3.1.4. Shoes and other footwear (footwear for men, ☐ No ☐ Yes ►
women, boys, girls and infants)
Page 19 of 33
Q1D.3.1.5. Repair of footwear, shoe cleaning services and ☐ No ☐ Yes ►

rental of footwear
TOTAL

Q1D.3.2 After the siege, did you or any member of your spend after the siege?
family purchase in cash or on credit, or receive as gift
any… credit gifts
Clothing
Q1D.3.2.1. Clothing Materials ☐ No ☐ Yes ►
Q1D.3.2.2. Garments (for men, boys, women, girls, infants, ☐ No ☐ Yes ►
sports activity, ties, handkerchiefs, sports garments like track
suits, leotards; and others like crash helmet for motorcycles
and bicycles, etc)
Q1D.3.2.3. Cleaning, repair and rental of clothing (incl. dry ☐ No ☐ Yes ►
cleaning, laundering, cleaning, dyeing services, altering of
garments)
Footwear
Q1D.3.2.4. Shoes and other footwear (footwear for men, ☐ No ☐ Yes ►
women, boys, girls and infants)
Q1D.3.2.5. Repair of footwear, shoe cleaning services and ☐ No ☐ Yes ►
rental of footwear
TOTAL
Housing, Water, Electricity, Gas and Other Fuels

Q1D.4.1 Before the siege, did you or any member of spend per month?
your family spend on… Total In cash/On Received as
credit gifts
Q1D.4.1.1. Actual rentals for housing ☐ No ☐ Yes ►
Q1D.4.1.2. Imputed rentals for housing (imputed rentals of ☐ No ☐ Yes ►
owners occupying main residence, imputed rentals for
secondary residence)
Q1D.4.1.3. Maintenance and repair of the dwelling (incl. ☐ No ☐ Yes ►
materials like pants, varnishes, wallpaper, cement, carpentry,
electrical, plumbing; services for the maintenance and repair
eg carpenters, painters, etc)
Q1D.4.1.4. Water supply and miscellaneous services ☐ No ☐ Yes ►
relating to the dwelling
Q1D.4.1.5. Electricity, Gas and other fuels (eg electricity, ☐ No ☐ Yes ►
kerosene, fuelwood, etc)
TOTAL

Q1D.4.2 After the siege, did you or any member of your spend per month?
family spend on… Total In cash/On Received as
credit gifts
Q1D.4.2.1. Actual rentals for housing ☐ No ☐ Yes ►
Page 20 of 33
Q1D.4.2.2. Imputed rentals for housing (imputed rentals of ☐ No ☐ Yes ►

owners occupying main residence, imputed rentals for
secondary residence)
Q1D.4.2.3. Maintenance and repair of the dwelling (incl. ☐ No ☐ Yes ►
materials like pants, varnishes, wallpaper, cement, carpentry,
electrical, plumbing; services for the maintenance and repair
eg carpenters, painters, etc)
Q1D.4.2.4. Water supply and miscellaneous services ☐ No ☐ Yes ►
relating to the dwelling
Q1D.4.2.5. Electricity, Gas and other fuels (eg electricity, ☐ No ☐ Yes ►
kerosene, fuelwood, etc)
TOTAL
Furnishings and Routine Household Maintenance

Q1D.5. Before the siege, did you or any member of your
spend in the past 6 months?
family purchase in cash or on credit or receive as gift,
In cash/On Received as
any Total
credit gifts
Q1D.5.1. Furnishings, Carpets and Other Floor Coverings ☐ No ☐ Yes ►
(inl, lighting, pictures, reproduced works of art; carpets, floor
coverings and repair of furniture, furnishings and floor
coverings)
Q1D.5.2. Household Textile (inlc. Beddings eg pillows, bed ☐ No ☐ Yes ►
sheets, pillow cases, blankets, mosquito nets, furnishing
fabrics, curtain materials, etc)
Q1D.5.3. Repair of household appliances ☐ No ☐ Yes ►
Q1D.5.4. Glassware, tableware, and household utensils, ☐ No ☐ Yes ►
small tools and miscellaneous accessories
Q1D.5.5. Goods and services for routine household ☐ No ☐ Yes ►
maintenance (incl non-durable household goods eg cleaning
and maintenance products like soaps, washing powders,
washing liquids, detergents, softeners; articles of cleaning eg
brooms, dustpans, sponge, steel wool; paper products eg
filters, table napkins, aluminum foil; polishes, creams,
matches, candles, clothes hangers, pins, sewing needles)
Q1D.5.6. Domestic and household services (eg cook, maid, ☐ No ☐ Yes ►
driver; window cleaning, fumigation, disinfecting, dry
cleaning, laundering of household textiles and carpets; hire
of furniture, furnishings, carpets, household equipment and
linen)
TOTAL

Q1D.5. After the siege, did you or any member of your
spend in the past 6 months?
any Total
credit gifts
Q1D.5.1. Furnishings, Carpets and Other Floor Coverings ☐ No ☐ Yes ►
(inl, lighting, pictures, reproduced works of art; carpets, floor
coverings and repair of furniture, furnishings and floor
coverings)
Page 21 of 33
Q1D.5.2. Household Textile (inlc. Beddings eg pillows, bed ☐ No ☐ Yes ►

sheets, pillow cases, blankets, mosquito nets, furnishing
fabrics, curtain materials, etc)
Q1D.5.3. Repair of household appliances ☐ No ☐ Yes ►
Q1D.5.4. Glassware, tableware, and household utensils, ☐ No ☐ Yes ►
small tools and miscellaneous accessories
Q1D.5.5. Goods and services for routine household ☐ No ☐ Yes ►
maintenance (incl non-durable household goods eg cleaning
and maintenance products like soaps, washing powders,
washing liquids, detergents, softeners; articles of cleaning eg
brooms, dustpans, sponge, steel wool; paper products eg
filters, table napkins, aluminum foil; polishes, creams,
matches, candles, clothes hangers, pins, sewing needles)
Q1D.5.6. Domestic and household services (eg cook, maid, ☐ No ☐ Yes ►
driver; window cleaning, fumigation, disinfecting, dry
cleaning, laundering of household textiles and carpets; hire
of furniture, furnishings, carpets, household equipment and
linen)
TOTAL
Health

Q1D.6. Before the siege, did you or any member of your spend?
any…
credit gifts
Medical Products
Q1D.6.1. Pharmaceutical Products (medicinal preparations, ☐ No ☐ Yes ►
drugs and patent medicines; pharmaceutical products for
nutrition and/or prevent diseases eg serums, vaccines, vitamins
and minerals, dietary supplements, cod and halibut liver oil,
other products for medical disinfectant; others)
Q1D.6.2. Other medicinal products (thermometer, bandages, ☐ No ☐ Yes ►
syringes, hot-water bottles and ice bags, medical hosiery
items like stocking or knee supports, pregnancy tests,
condoms and other contraceptive devices)
Q1D.6.3. Therapeutic Aids (corrective eyeglasses, contact ☐ No ☐ Yes ►
lenses, hearing aids, dentures except fitting costs, etc)
Outpatient Medical Services

Q1D.6.4. Medical Services (general medical services availed ☐ No ☐ Yes ►
like consultation, physical check-up, laboratory services from
private or public services; specialized medical services
availed of analysis and interpretation of medical images)
Dental Services
Q1D.6.5. Paramedical services (eg medical analysis ☐ No ☐ Yes ►
laboratories and x-ray centers; medical acupuncturists,
optometrists, etc)
Hospital Services
Q1D.6.6. Hospital Services - Inpatient services of both public ☐ No ☐ Yes ►
and private services)
TOTAL
Page 22 of 33

Q1D.6. After the siege, did you or any member of your spend?
any…
credit gifts
Medical Products
Q1D.6.1. Pharmaceutical Products (medicinal preparations, ☐ No ☐ Yes ►
drugs and patent medicines; pharmaceutical products for
nutrition and/or prevent diseases eg serums, vaccines, vitamins
and minerals, dietary supplements, cod and halibut liver oil,
other products for medical disinfectant; others)
Q1D.6.2. Other medicinal products (thermometer, bandages, ☐ No ☐ Yes ►
syringes, hot-water bottles and ice bags, medical hosiery
items like stocking or knee supports, pregnancy tests,
condoms and other contraceptive devices)
Q1D.6.3. Therapeutic Aids (corrective eyeglasses, contact ☐ No ☐ Yes ►
lenses, hearing aids, dentures except fitting costs, etc)
Outpatient Medical Services

Q1D.6.4. Medical Services (general medical services availed ☐ No ☐ Yes ►
like consultation, physical check-up, laboratory services from
private or public services; specialized medical services
availed of analysis and interpretation of medical images)
Dental Services
Q1D.6.5. Paramedical services (eg medical analysis ☐ No ☐ Yes ►
laboratories and x-ray centers; medical acupuncturists,
optometrists, etc)
Hospital Services
Q1D.6.6. Hospital Services - Inpatient services of both public ☐ No ☐ Yes ►
and private services)
TOTAL
Transport

Q1D.7. Before the siege, did you or any member of your spend per month?
family spend on… In cash/On Received as
Total
credit gifts
Q1D.7.1. Operation of Personal Transport Equipment (spare ☐ No ☐ Yes ►
parts and accessories such as tires, batteries; fuel and
lubricants incl transmission fluids, coolants and additives;
maintenance and repair of personal transport such as wheel
alignment, tune-up, change oil; other services such as toll
facilities and parking, driving lessons, tests and licensces,
other services)
Q1D.7.2. Transport Serrvices (passenger transport by ☐ No ☐ Yes ►
railway, road like jeepney, bus, taxi, tricycle, pedicab, ev
express, TNVS; transport by air both domestic and
international; transport by sea and inland waterway; RORO,
other purchases transport services)
TOTAL
Page 23 of 33

Q1D.7. After the siege, did you or any member of your spend per month?
Total
credit gifts
Q1D.7.1. Operation of Personal Transport Equipment (spare ☐ No ☐ Yes ►
parts and accessories such as tires, batteries; fuel and
lubricants incl transmission fluids, coolants and additives;
maintenance and repair of personal transport such as wheel
alignment, tune-up, change oil; other services such as toll
facilities and parking, driving lessons, tests and licensces,
other services)
Q1D.7.2. Transport Serrvices (passenger transport by ☐ No ☐ Yes ►
railway, road like jeepney, bus, taxi, tricycle, pedicab, ev
express, TNVS; transport by air both domestic and
international; transport by sea and inland waterway; RORO,
other purchases transport services)
TOTAL
Communication
Q1D.7. Before the siege, did you or any member of your spend per month?
Total
credit gifts
Q1D.7.1. Postal Services ☐ No ☐ Yes ►
Q1D.7.2. Telephone and telefax services (installation and ☐ No ☐ Yes ►
subscription cost of landline, internet, postpaid cellular,
prepaid communication)
TOTAL

Q1D.7. After the siege, did you or any member of your spend per month?
Total
credit gifts
Q1D.7.1. Postal Services ☐ No ☐ Yes ►
Q1D.7.2. Telephone and telefax services (installation and ☐ No ☐ Yes ►
subscription cost of landline, internet, postpaid cellular,
prepaid communication)
TOTAL
Page 24 of 33
Recreation and Culture

any… Total
credit gifts
Q1D.8.1. Audio-visual photography and Information ☐ No ☐ Yes ►
Processing (incl equipment for reception, recording and
reproduction of sound and pictures like microphones,
earphones and headphones; photographic and
cinematographic equipment and optimal instruments, incl
microscope; information processing equipment such as
calculators; recording media; and repair of audio-visual
photographic and info processing equipment)
Q1D.8.2. Maintenance and repair of other major durables for ☐ No ☐ Yes ►
recreation and culture
Q1D.8.3. Other recreational items and equipment, gardens ☐ No ☐ Yes ►
and pets (games, toys and hobbies eg card, stamp
collections, video games; equipment for sport, camping and
open-air recreation; gardens, plans and flowers; pets and
related products eg, pet food)
Q1D.8.4. Recreational and Cultural (recreational, sports and ☐ No ☐ Yes ►
cultural services like sport stadiums, tennis, volleyball,
skating rinks, cable subscription, cinemas, theaters; game of
chance like service charge for lotteries, casinos, bingo hall,
scratch cards)
Q1D.8.5. Newspaper, books and stationery (including ☐ No ☐ Yes ►
drawing materials such as writing pads, envelopes,
notebooks, pens, pencils, ink, erasers, etc)
Q1D.8.6. Package Tour (package tours, half-day and one- ☐ No ☐ Yes ►
day excursion tours, pilgrimages)
Q1D.8.7. Independent Traveler (total expenditure on
varieties of tourism products and services such as transport,
accommodation, food services, recreation, etc.)
TOTAL
Page 25 of 33

any… Total
credit gifts
Q1D.8.4. Recreational and Cultural (recreational, sports and ☐ No ☐ Yes ►
cultural services like sport stadiums, tennis, volleyball,
skating rinks, cable subscription, cinemas, theaters; game of
chance like service charge for lotteries, casinos, bingo hall,
scratch cards)
Q1D.8.5. Newspaper, books and stationery (including ☐ No ☐ Yes ►
drawing materials such as writing pads, envelopes,
notebooks, pens, pencils, ink, erasers, etc)
Q1D.8.6. Package Tour (package tours, half-day and one- ☐ No ☐ Yes ►
day excursion tours, pilgrimages)
Q1D.8.7. Independent Traveler (total expenditure on
varieties of tourism products and services such as transport,
accommodation, food services, recreation, etc.)
TOTAL
Page 26 of 33
Education
any… Total
credit gifts
Q1D.9.1. Tuition Fees (all levels, incuding Tech-voc or post- ☐ No ☐ Yes ►
secondary non-tertiary education)
Q1D.9.2. Education not definable by level (review center, ☐ No ☐ Yes ►
computer training, etc)
Q1D.9.3. Allowance for family member studying away from ☐ No ☐ Yes ►
home (not enumerated as member of the household)
Q1D.9.4. Other educational expenses (school uniform and ☐ No ☐ Yes ►
footwear, computer rental and printing services, others)
TOTAL

any… Total
credit gifts
Q1D.9.1. Tuition Fees (all levels, incuding Tech-voc or post- ☐ No ☐ Yes ►
secondary non-tertiary education)
Q1D.9.2. Education not definable by level (review center, ☐ No ☐ Yes ►
computer training, etc)
Q1D.9.3. Allowance for family member studying away from ☐ No ☐ Yes ►
home (not enumerated as member of the household)
Q1D.9.4. Other educational expenses (school uniform and ☐ No ☐ Yes ►
footwear, computer rental and printing services, others)
TOTAL
Restaurant and Hotels

any… Total
credit gifts
Q1D.10.1. Restaurants, cafes and the like (incl catering ☐ No ☐ Yes ►
services provided by restaurants, buffets, bars, places
providing recreational, cultural, sporting or entertainment
services, swimming pools, sport complexes, museums, art
galleries, nightclubs, dancing establishments, on public
transport (coaches, trains, boats, airplanes, etc.; Sale of food
products and beverages for immediate consumption by
kiosks, street vendors and the like, including food products
and beverages dispensed ready for consumption by
automatic vending machines; Sale of cooked dishes for
consumption off their premises)
Q1D.10.2. Canteens (work canteens, office canteens, and ☐ No ☐ Yes ►
canteen in schools, universities and other educational
establishments; university refectories, military messes and
wardrooms)
Page 27 of 33
Q1D.10.3. Accommodation Services (Expenses on hotels, ☐ No ☐ Yes ►

boarding houses, motels, inns and establishments offering
“bed and breakfast”, condominium-hotel, and other
accommodation services, n.e.c.)
services, swimming pools, sport complexes, museums, art,
TOTAL

any… Total
credit gifts
services, swimming pools, sport complexes, museums, art
Q1D.10.2. Canteens (work canteens, office canteens, and ☐ No ☐ Yes ►
canteen in schools, universities and other educational
establishments; university refectories, military messes and
wardrooms)
Q1D.10.3. Accommodation Services (Expenses on hotels, ☐ No ☐ Yes ►
boarding houses, motels, inns and establishments offering
“bed and breakfast”, condominium-hotel, and other
accommodation services, n.e.c.)
services, swimming pools, sport complexes, museums, art,
TOTAL
Page 28 of 33
Miscellaneous Goods and Services

Q1D.11. Before the siege, did you or any member spend?
of your family spend on… In cash/On Received as
Total
credit gifts
Q1D.11. 1. Personal care (Hairdressing Salons and Personal ☐ No ☐ Yes ►
Grooming establishments such as services of hairdressing
salon and beauty parlor, barbershop, spas saunas, non-
medical massages; electrical appliances for persona care
(Electric razors and hair trimmers, hand-held and hood hair
dryers, curling tongs, etc.); other appliances and products for
personal care like razors, blades, nail files, combs,
toothbrushes, personal hygiene like toilet, soap toothpaste,
shampoo, conditioners, beauty products like lipstick, make-
up, lotions, deodorants, and other products like toilet paper,
napkins, shower cap, etc)
Q1D.11.2. Personal effects (such as jewelry, clocks, ☐ No ☐ Yes ►
watches, handbags, travel bag, wallet, purse, articles for
babies like strollers, umbrella, sunglasses, funerary articles
like coffins, gravestones)
Q1D.11.3. Social Protection (retirement homes for elderly ☐ No ☐ Yes ►
persons, residences for persons with disability, etc.)
Q1D.11.4. Insurance (life and non0life insurance like ☐ No ☐ Yes ►
housing, health and transport insurance)
Q1D.11.5. Financial services (financial charges of banks, ☐ No ☐ Yes ►
LBC, Cebuana, Palawan, Western Union, etc.)
Q1D.11.6. Other services, n.e.c. (fees for legal services, ☐ No ☐ Yes ►
payment for photocopies, fees for the issuance of birth,
marriage and death certificates, service charges in bayad
centers, etc.)
TOTAL

Q1D.11. After the siege, did you or any member of spend?
your family spend on… In cash/On Received as
Total
credit gifts
Q1D.11. 1. Personal care (Hairdressing Salons and Personal ☐ No ☐ Yes ►
Grooming establishments such as services of hairdressing
salon and beauty parlor, barbershop, spas saunas, non-
medical massages; electrical appliances for persona care
(Electric razors and hair trimmers, hand-held and hood hair
dryers, curling tongs, etc.); other appliances and products for
personal care like razors, blades, nail files, combs,
toothbrushes, personal hygiene like toilet, soap toothpaste,
shampoo, conditioners, beauty products like lipstick, make-
up, lotions, deodorants, and other products like toilet paper,
napkins, shower cap, etc)
Q1D.11.2. Personal effects (such as jewelry, clocks, ☐ No ☐ Yes ►
watches, handbags, travel bag, wallet, purse, articles for
babies like strollers, umbrella, sunglasses, funerary articles
like coffins, gravestones)
Q1D.11.3. Social Protection (retirement homes for elderly ☐ No ☐ Yes ►
persons, residences for persons with disability, etc.)
Q1D.11.4. Insurance (life and non0life insurance like ☐ No ☐ Yes ►
housing, health and transport insurance)
Q1D.11.5. Financial services (financial charges of banks, ☐ No ☐ Yes ►
LBC, Cebuana, Palawan, Western Union, etc.)
Q1D.11.6. Other services, n.e.c. (fees for legal services, ☐ No ☐ Yes ►
payment for photocopies, fees for the issuance of birth,
marriage and death certificates, service charges in bayad
centers, etc.)
TOTAL
Page 29 of 33
Durable Furniture and Equipment

Q1D.12. Before the siege , did you or any member of your spend?
any… Total
credit gifts
Q1D.12.1. Furniture ☐ No ☐ Yes ►
Q1D.12.2. Major household appliances ☐ No ☐ Yes ►
Q1D.12.3. Small electric household appliances (electric fan, ☐ No ☐ Yes ►
rice cooker, flat iron, toaster, blender, coffee maker, etc)
Q1D.12.4. Major tools and equipment (electric drills, saws, ☐ No ☐ Yes ►
lawn mowers, etc.)
Q1D.12.5. Transport equipment for household use (eg motor ☐ No ☐ Yes ►
cars, motorcycles/tricycles, bicycles, etc)
Q1D.12.6. Major household equipments (cellphone, landline ☐ No ☐ Yes ►
phone, telefax machine)
Q1D.12.7. Audio-visual equipments (radio, TV, cameras, ☐ No ☐ Yes ►
desktop computer, laptop, printer, scanner)
Q1D.12.8. Other major durables for recreation and culture ☐ No ☐ Yes ►
(major durables for outdoor recreation like camper
vans/caravans, airplanes, boats, hoses and ponies; musical
instruments and major durables for indoor recreation like
pianos, keyboard, guitar, violin, other musical instruments)
TOTAL

any… Total
credit gifts
Q1D.12.1. Furniture ☐ No ☐ Yes ►
Q1D.12.2. Major household appliances ☐ No ☐ Yes ►
Q1D.12.3. Small electric household appliances (electric fan, ☐ No ☐ Yes ►
rice cooker, flat iron, toaster, blender, coffee maker, etc)
Q1D.12.4. Major tools and equipment (electric drills, saws, ☐ No ☐ Yes ►
lawn mowers, etc.)
Q1D.12.5. Transport equipment for household use (eg motor ☐ No ☐ Yes ►
cars, motorcycles/tricycles, bicycles, etc)
Q1D.12.6. Major household equipments (cellphone, landline ☐ No ☐ Yes ►
phone, telefax machine)
Q1D.12.7. Audio-visual equipments (radio, TV, cameras, ☐ No ☐ Yes ►
desktop computer, laptop, printer, scanner)
Q1D.12.8. Other major durables for recreation and culture ☐ No ☐ Yes ►
(major durables for outdoor recreation like camper
vans/caravans, airplanes, boats, hoses and ponies; musical
instruments and major durables for indoor recreation like
pianos, keyboard, guitar, violin, other musical instruments)
TOTAL
Special Family Occasions

Q1D.13.1. Before the siege , did you or any member of If YES, how much on the
your family purchase in cash or on credit any food or pay for services for average did you spend?
special family occasions such as… Total
Q1D.13.1.2. Food and refreshments ☐ No ☐ Yes ►
Q1D.13.1.3. Alcoholic beverages ☐ No ☐ Yes ►
Q1D.13.1.4. Service of priests, cooks, waiters, etc. ☐ No ☐ Yes ►
Q1D.13.1.5. Rental of space, facilities and equipment ☐ No ☐ Yes ►
Q1D.13.1.6. Others (balloons, flowers, candles, paints, funeral charges, ☐ No ☐ Yes ►
cremation, firecrackers, etc.)
TOTAL
Q1D.13.2. Before the siege, did you or any member of your family receive as If YES, how much is the
gifts any food and free services for special family occasions? estimated value of these?
Total Value
Page 30 of 33

TOTAL
Q1D.13.1. After the siege, did you or any member of If YES, how much on the
your family purchase in cash or on credit any food or pay for services for average did you spend?
special family occasions such as… Total
TOTAL
Q1D.13.2.After the siege, did you or any member of your family receive as If YES, how much is the
gifts any food and free services for special family occasions? estimated value of these?
Total Value
TOTAL
Other expenditures

family pay taxes such as income tax, real estate tax, and
other direct taxes and or give gifts and contribution to others
in cash or in kind? In Cash In Kind
Q1D.14.1. Taxes (income, real estate, other direct taxes like ☐ No ☐ Yes ►
community tax certificate)
Q1D.14.2. Gifts and contributions to others (Gifts and assistance ☐ No ☐ Yes ►
to private individuals outside the family, contributions to
church/religious institutions, donations to institutions, gifts to
birthdays, weddings, etc)
Q1D.14.3. Other (losses due to fire and theft, etc) ☐ No ☐ Yes ►
TOTAL

Q1D.14. After the siege, did you or any member of your family spend?
pay taxes such as income tax, real estate tax, and other
direct taxes and or give gifts and contribution to others in
cash or in kind? In Cash In Kind
Q1D.14.1. Taxes (income, real estate, other direct taxes like ☐ No ☐ Yes ►
community tax certificate)
Q1D.14.2. Gifts and contributions to others (Gifts and assistance ☐ No ☐ Yes ►
to private individuals outside the family, contributions to
church/religious institutions, donations to institutions, gifts to
birthdays, weddings, etc)
Q1D.14.3. Other (losses due to fire and theft, etc) ☐ No ☐ Yes ►
TOTAL
Page 31 of 33
Other disbursements
If YES, how much on the

average did you spend?
Q1D.15. Before the siege, you or any member of your family incur any expenses,
in cash or on credit, on other disbursement such as …
Total Value
Q1D.15.1. Purchase/amortization of real property ☐ No ☐ Yes ►
Q1D.15.2. Payments of cash loan (principal) ☐ No ☐ Yes ►
Q1D.15.3. Installments for appliances, etc. bought before 2018 ☐ No ☐ Yes ►
Q1D.15.4. Installments for personal transport bought before 2018 ☐ No ☐ Yes ►
Q1D.15.5. Loans granted to persons outside the family ☐ No ☐ Yes ►
Q1D.15.6. Amount deposited in banks/investments (Pag-ibig) ☐ No ☐ Yes ►
Q1D.15.7. Major repair of the house ☐ No ☐ Yes ►
Q1D.15.8. Construction of new house ☐ No ☐ Yes ►
Q1D.15.9. Other disbursements (Withholding taxes from current income, payment ☐ No ☐ Yes ►
for goods/services acquired/availed of outside reference period, back rentals paid
during reference period, architectural and interior designing, property rights bought
during the reference period, etc.)
TOTAL
If YES, how much on the

average did you spend?
Q1D.15. After the siege, you or any member of your family incur any expenses,
in cash or on credit, on other disbursement such as …
Total Value
Q1D.15.1. Purchase/amortization of real property ☐ No ☐ Yes ►
Q1D.15.2. Payments of cash loan (principal) ☐ No ☐ Yes ►
Q1D.15.3. Installments for appliances, etc. bought before 2018 ☐ No ☐ Yes ►
Q1D.15.4. Installments for personal transport bought before 2018 ☐ No ☐ Yes ►
Q1D.15.5. Loans granted to persons outside the family ☐ No ☐ Yes ►
Q1D.15.6. Amount deposited in banks/investments (Pag-ibig) ☐ No ☐ Yes ►
Q1D.15.7. Major repair of the house ☐ No ☐ Yes ►
Q1D.15.8. Construction of new house ☐ No ☐ Yes ►
Q1D.15.9. Other disbursements (Withholding taxes from current income, payment ☐ No ☐ Yes ►
for goods/services acquired/availed of outside reference period, back rentals paid
during reference period, architectural and interior designing, property rights bought
during the reference period, etc.)
TOTAL
DISASTER SUSCEPTIBILITY
If YES, how often?

Q1D.16. Before the siege, did you or any member
of your family experience any of the following # of
Cost of Lives lost
incidents… incidents
damage
Q1D.16.1 Flooding ☐ No ☐ Yes ►

Q1D.16.2 Earthquake ☐ No ☐ Yes ►
Q1D.16.3. Fire ☐ No ☐ Yes ►
Q1D.16.4. Storm Surge ☐ No ☐ Yes ►
Q1D.16.5. Other. Specify____________ ☐ No ☐ Yes ►
TOTAL
Page 32 of 33
If YES, how often?

Q1D.16. After the siege, did you or any member of
your family experience any of the following # of
Cost of Lives lost
incidents… incidents
damage
Q1D.16.1 Flooding ☐ No ☐ Yes ►

Q1D.16.2 Earthquake ☐ No ☐ Yes ►
Q1D.16.3. Fire ☐ No ☐ Yes ►
Q1D.16.4. Storm Surge ☐ No ☐ Yes ►
Q1D.16.5. Other. Specify____________ ☐ No ☐ Yes ►
TOTAL
Before the Siege After the Siege
Did you experience transferring to other areas because of unlivable condition of

Q1D.16.6
the house caused by disaster?
Did you experience transferring to other areas because of the unbearable noise
Q1D.16.7
pollution in the vicinity of your area?
Are wastes being collected by the Waste Management Authority in your area?
Q1D.16.8
What types of waste are being collected in your area? (Solid, Liquid)
Q1D.16.9
Module 1.E. Perception Survey

Q1E Satisfaction Code
Please rate your satisfaction on the following… Satisfaction Code Very satisfied 3
Satisfied 2
Less satisfied 1
Q1E.1.1 House / Dwelling Place

Q1E.1.2 Location
Q1E.1.3 Neighborhood
Q1E.1.4 Employment opportunities
Note:
For Composite Reliability and Average Variance Extraction
This survey instrument will be tested for reliability using a test of variance, the square of variance, and error of variance for each variable in the instrument to determine
the Composite Reliability (CR) and Average Variance Extraction (AVE) using SPSS and Excel statistical software.
Composite Reliability (CR )=¿ ¿
Average Variance Extracted=¿¿ ¿

Where:
∑ ❑ = Total Variance
¿ ¿ = The Square of Total Variance
ε ❑ = (1 - ❑2 ¿ Error of Variance
N = Number of samples
*Adopted from NEDA-IPG-IE Standard Questionnaire
Page 33 of 33

Annex A Questionnaire Refined Jan2024 1

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Annex A Questionnaire Refined Jan2024 1

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Annex A PSA Approval No.

Your cooperation is earnestly solicited.

Signature of Respondent or Thumbprint Signature of Interviewer Signature of Data Controller:

Date: Date: Date:

Household Information RECORD OF VISIT

Date Accomplished Date Reviewed

Enumerator’s Copy Page 1 of 33

Your cooperation is earnestly solicited.

Signature of Respondent or Thumbprint Signature of Interviewer Signature of Data Controller:

Date: Date: Date:

Household’s Copy Page 2 of 33

Q2. Age (as of last birthday): ………………………….. Roman Catholic 1 Islam 5

Q6. How long have you resided in the

*Codes for Region and Province

Module 1.A Assets and Household Amenities

Q1A.2. In what type of Single house

Institutional living quarter 5

Q1A.9. What is the Pipe into dwelling Tanker truck

Q1A.12. What is the

Agricultural crop 4 Wood 11

Animal dung 5 Butane 12

Coal, lignite 7 No food cooked in household 14

Q1A.15. Does the household own any of the following assets?

Before After Before After

Q1A.16. Does your family subscribe to any

Cable (eg SKYCable, Destiny, Cignal, etc)

Rest of 1.A. is to be asked to the respondent (Before the siege condition)

construction materials stone, wood, plywood) Materials

Module 1.B. Household Demographic and Socio-economic Characteristics

Ask the succeeding questions for each household member.

dMarital Status Codes (Q1B.8) hType of School (Q1B.12)

Q1B.13. How many household members are there in total? 🖵

Before the siege

Answer) CASH EARNINGS EARNINGS IN KIND CASH EARNINGS EARNINGS IN KIND

After the siege

Answer) CASH EARNINGS EARNINGS IN KIND CASH EARNINGS EARNINGS IN KIND

Salaries Honoraria Salaries Clothing, Salaries Honoraria Salaries Clothing,

If respondent indicated codes 2 or 3 in Q1C.4 ► skip Q1C.8.1.1 to Q1C.8.1.4

If respondent indicated code 1 in Q1C.4 ►skip Q1C.8.2.1 to Q1C.8.2.4

Q1C.9.11 ACTIVITIES NOT ELSEWHERE CLASSIFIED including ►

RENTALS RECEIVED FROM NON-AGRICULTURAL LANDS, BUILDINGS,

PENSION AND RETIREMENT, EMPLOYEE COMPENSATION AND SOCIAL

Approval No.: NEDA - 2337

Unconditional Cash Indigent Senior Citizen’s

Approval No.: NEDA - 2337

Unconditional Cash Indigent Senior Citizen’s

Module 1.D. Household Expenditure

If YES, how much on the average do you

Alcoholic Beverages and Tobacco

If YES, how much on the average do you spend

Q1D.2.1.2Tobacco (cigarette, cigars, chewing tobacco, ☐ No ☐ Yes ►

If YES, how much on the average do you spend

Q1D.2.2.2 Tobacco (cigarette, cigars, chewing tobacco, ☐ No ☐ Yes ►

Clothing and footwear

Q1D.3.1.5. Repair of footwear, shoe cleaning services and ☐ No ☐ Yes ►

If YES, how much on the average did you

Housing, Water, Electricity, Gas and Other Fuels

If YES, how much on the average do you

Q1D.4.2.2. Imputed rentals for housing (imputed rentals of ☐ No ☐ Yes ►

Furnishings and Routine Household Maintenance

If YES, how much on the average did you

Q1D.5.2. Household Textile (inlc. Beddings eg pillows, bed ☐ No ☐ Yes ►